The Need for Emergency Medicine Resident Training in Informed Consent for Procedures

Gaeta, Theodore J.; Torres, Rafael Augusto Tamasauskas; Kotamraju, Radha; Seidman, Carly; Yarmush, Joel

doi:10.1111/j.1553-2712.2007.tb02352.x

Cited by 17 publications

(15 citation statements)

References 11 publications

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“…The markedly lower consent rates when additional and specific information was given regarding how the trainee will be participating highlights the need to carefully evaluate not only the results of this and other studies but also the exact wording of the questions and response choices. Although this and other studies 11,17 have found decreased consent rates when additional information regarding trainee participation is provided, it is unclear whether these effects could be counterbalanced by educating patients regarding the positive aspects of care in a teaching setting. Our results suggest that patient understanding and perceptions may significantly affect their attitude toward surgical education.…”

Section: Commentmentioning

confidence: 57%

“…Trainees themselves have frequently not volunteered this information, particularly in the setting of obtaining consent for an invasive procedure. 11,14 In a detailed interview of 30 attending surgeons in an academic hospital, Knifed et al 5 found that most (83%) did not volunteer information regarding trainee participation during the informed consent process. They also demonstrated the willingness of attending surgeons to allow active trainee participation, with 87% allowing residents to operate while the attending surgeon was not adequately dressed and washed for surgery but was present and 77% allowing residents to operate when their attending surgeon was not present in the operating room.…”

Section: Commentmentioning

confidence: 99%

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Training Surgeons and the Informed Consent Process

Porta¹

2012

Arch Surg

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Objectives: To examine patient perceptions and willingness to participate in resident education and to assess the effect on patient willingness and consent rates.Design: Anonymous questionnaire designed to capture demographics, overall opinions of teaching programs, and willingness to consent to various scenarios of trainee participation. Descriptive and univariate analyses were performed.Setting: Tertiary-level referral center.Patients: Three hundred sixteen individuals scheduled for elective surgery. Main Outcome Measures: Consent rates for various scenarios.Results: Of the 316 patients who completed the questionnaire, most expressed overall support of resident training: 91.2% opined that their care would be equivalent to or better than that of a private hospital, 68.3% believed they derived benefit from participation, and most con-sented to having an intern (85.0%) or a resident (94.0%) participate in their surgical procedure. However, when given specific, realistic scenarios involving trainee participation, major variations in the consent rate were observed. Affirmative consent rates decreased from 94.0% to 18.2% as the level of resident participation increased. Patients also were more willing to consent to the participation of a senior resident (83.1%) vs a junior resident (57.6%) or an intern (54.5%). Patients overwhelmingly opined that they should be informed of the level of resident participation and that this information could change their decision of whether to consent.Conclusions: Most patients expressed approval of teaching facilities and resident education. However, consent rates were significantly altered when more detailed information was provided and they declined with increasing levels of resident participation. Providing detailed informed consent is preferred by patients but it could adversely affect resident participation and training.

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Section: Commentmentioning

confidence: 57%

Section: Commentmentioning

confidence: 99%

Training Surgeons and the Informed Consent Process

Porta¹

2012

Arch Surg

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“…Residents performed worse compared to surgeons in Ireland, Germany, UK and USA [23-25,28]. They do not feel confident due to a lack of training [5,13,23,24,26,29], and up to 60% of residents in the USA claimed that they never received any feedback on these issues during their residency [29,30]. In recent years, informed consent was topic of debate in the USA and the UK and improvements in care followed.…”

Section: Discussionmentioning

confidence: 99%

A survey of the current practice of the informed consent process in general surgery in the Netherlands

et al. 2013

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BackgroundA properly conducted surgical informed consent process (SIC) allows patients to authorize an invasive procedure with full comprehension of relevant information including involved risks. Current practice of SIC may differ from the ideal situation. The aim of this study is to evaluate whether SIC practiced by Dutch general surgeons and residents is adequate with involvement of all required elements.MethodsAll members of the Dutch Society of Surgery received an online multiple choice questionnaire evaluating various aspects of SIC.ResultsA total of 453 questionnaires obtained from surgeons and residents representing >95% of all Dutch hospitals were eligible for analysis (response rate 30%). Knowledge on SIC was limited as only 55% was familiar with all three basic elements (‘assessment of preconditions’, ‘provision of information’ and ‘stage of consent’). Residents performance was inferior compared to surgeons regarding most aspects of daily practice of SIC. One in 6 surgeons (17%) had faced a SIC-related complaint in the previous five years possibly illustrating suboptimal SIC implementation in daily surgical practice.ConclusionsThe quality of the current SIC process is far from optimal in the Netherlands. Surgical residents require training aimed at improving awareness and skills. The SIC process is ideally supported using modern tools including web-based interactive programs. Improvement of the SIC process may enhance patient satisfaction and may possibly reduce the number of complaints.

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“…The junior doctors particularly the residents are usually the front line healthcare providers in developing as well as developed countries, however they are often not well versed with the process of SIC, and hence err by not giving information about the potential complications of the planned procedures or alternative treatments and mostly provide only information on the benefits of particular surgical interventions (13)(14)(15). Lack of practical experience as well as deficient training on part of the residents in the critical area of doctor-patient communication are the possible explanations for their poor performance in the process of SIC (7,9,(16)(17)(18)(19)(20). Our findings of the study constitute a compelling evidence for educating residents in this particular area of doctor-patient communication in future.…”

Section: Discussionmentioning

confidence: 99%

An audit of the knowledge and attitudes of doctors towards Surgical Informed Consent (SIC)

Ashraf

Tasnim

Saaiq

et al. 2014

Int J Health Policy Manag

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Background: The Surgical Informed Consent (SIC) is a comprehensive process that establishes an informationbased agreement between the patient and his doctor to undertake a clearly outlined medical or surgical intervention. It is neither a casual formality nor a casually signed piece of paper. The present study was designed to audit the current knowledge and attitudes of doctors towards SIC at a tertiary care teaching hospital in Pakistan. Methods: This cross-sectional qualitative investigation was conducted under the auspices of the Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad over three months period. A 19-item questionnaire was employed for data collection. The participants were selected at random from the list of the surgeons maintained in the hospital and approached face-to-face with the help of a team of junior doctors detailed for questionnaire distribution among them. The target was to cover over 50% of these doctors by convenience sampling. Results: Out of 231 respondents, there were 32 seniors while 199 junior doctors, constituting a ratio of 1:6.22. The respondents variably responded to the questions regarding various attributes of the process of SIC. Overall, the junior doctors performed poorer compared to the seniors. Conclusion:The knowledge and attitudes of our doctors particularly the junior ones, towards the SIC are less than ideal. This results in their failure to avail this golden opportunity of doctor-patient communication to guide their patients through a solidly informative and legally valid SIC. They are often unaware of the essential preconditions of the SIC; provide incomplete information to their patients; and quite often do not ensure direct involvement of their patients in the process. Additionally they lack an understanding of using interactive computer-based programs as well as the concept of nocebo effect of informed consent.

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The Need for Emergency Medicine Resident Training in Informed Consent for Procedures

Cited by 17 publications

References 11 publications

Training Surgeons and the Informed Consent Process

Training Surgeons and the Informed Consent Process

A survey of the current practice of the informed consent process in general surgery in the Netherlands

An audit of the knowledge and attitudes of doctors towards Surgical Informed Consent (SIC)

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